關節盤及關節頭形態對咬合板治療顳顎關節盤脫位的影響

The Influence of Disc and Condyle Morphology on Outcome of Splint Therapy for Anterior Disc Displacement with Reduction of Temporomandibular Joint

許經偉(Ching-Wei Shu) ； 黃麗玲(Li-Ling Huang) ； 高郁勛(Yi-Hsen Kao) ； 黃逸岳(I-Yueh Huang) ； 陳中和(Chung-Ho Chen)

《臺灣口腔顎面外科學會雜誌》 24卷3期 (2013/09) Pp. 151-160

摘要

顳顎關節盤可復性前移位是臨床醫師常需面對及治療的一特定族群，本研究即探討此類病患，經核磁共振影像確診後，其常見關節盤形態為何，以及探討臨床上病患配戴咬合板時，關節聲響或症狀消失時，實際關節盤和關節頭相對位置關係為何。最後分析關節盤及關節頭形態，是否對咬合板治療的成效造成影響。本研究收錄38位核磁共振影像確立診斷為顳顎關節盤可復性前移位的病患（總關節數40個），結果顯示關節盤形態以正常雙凹形最多，占37.5%（32.5%摺疊形，25.0%後緣增厚形，5.0%細長形）。其中27位病患（總關節數28個）同時配戴咬合板接受核磁共振攝影，結果顯示高達96.4%的『關節頭－關節盤』相互關係為臨床上可接受治療關係（75.0%關節盤完整復位到正常關係，21.4%關節盤部份復位到關節頭上方，3.6%關節無復位產生）。於治療療程結束後半年時間，本研究追踪到30位病患（總關節數32個），再次收集相關臨床資料，進而探討此30位病患的半年後成功率是否因關節盤或關節頭形變而受影響。本研究使用Fisher's exact test及Chi-square test統計方法，結果並無統計上顯著差異。

關鍵字

關節盤可復性前移位 ； 核磁共振影像 ； 咬合板 ； 關節頭 ； 關節盤

並列摘要

The anterior disc displacement with reduction of TMJ (ADDR) is a particular disorder that clinicians always encounter and is need to treat. In this study, after MRI confirmation of ADDR, we observed the most common disc morphology of these patients and the immediate TMJ condyle-disc relationship after wearing occlusal splint, which is designed to relieve clicking or intermittent locking. Moreover, we also evaluated whether the therapeutic outcome would be influenced by the morphology of condyle or disc.The study recruited 38 patients with diagnosis of ADDR by MRI. The total number of involved jointswas 40. The most common morphology of disc within ADDR was normal biconcave shape, accounting for 37.5 % (folded: 32.5%, thick posterior band: 25.0 %, flattening: 5.0%). Among these patients, 27 patients wore splint simultaneously have taken MRI. There was near 96.4% responsive rate after wearing occlusal splint (75.0% complete disc recapture, 21.4% partial disc recapture, 3.6% no disc recapture). Six months finishing the splint treatment course, we followed 30 patients (total 32 joints) and evaluated whether success rate of splint therapy was influenced by the morphology of condylar head or disc. Fisher's exact test and Chi-square test were used to analyze the correlation. Although there was no statistically significant result, these clinical covariates related to ADDR still need further investigation.

並列關鍵字

ADDR ； occlusal splint ； MRI ； condyle head ； disc morphology